How should the UK respond to the Ukrainian migrant crisis?
BMJ 2022; 377 doi: https://doi.org/10.1136/bmj.o1191 (Published 16 May 2022) Cite this as: BMJ 2022;377:o1191Linked Opinion
The health needs of refugees from Ukraine
In the horror and confusion of the war in Ukraine, the immediate healthcare needs of displaced people are clear.1 With over five million people crossing the border to leave, health must remain a priority in our global response to the conflict. Aid agencies are providing lifesaving assistance and medical supplies in Ukraine and neighbouring countries, but how should the UK respond to the health needs of people seeking refuge from the war?
Safe and legal routes
We must first ensure safe and legal ways for Ukrainian refugees to reach the UK. Otherwise, refugees are forced to take dangerous routes to claim asylum.23 The current approach to Ukrainian refugees, which limits visas to those with a family member or named sponsor in the UK and requires people to undergo security checks to acquire a visa before arriving, is too restrictive, slow, and bureaucratic.4 Of the estimated 5.7 million people who have fled Ukraine, just 27 100 have arrived in the UK through this route,5 and reports are increasing of Ukrainian refugees travelling to the UK without a visa.6
Once Ukrainians arrive in the UK, they need a fair, humane, timely, and effective refugee system. People who secure a visa in advance can stay in the UK for up to three years, but those without will be subjected to an asylum system that is notoriously slow and inefficient, with substantial effects on health. Although most people who make asylum claims are granted refugee status,7 the average waiting time for a claim to be decided is between one and three years.8
Evidence shows that asylum seekers and people with temporary immigration status experience particularly poor physical and mental health. This is often attributed to spending long periods of time in a state of uncertainty and the constant fear of being returned to an unsafe country as well as poor access to health services.9101112
While asylum claims are considered, people are accommodated in communal sites that are inappropriate for longer term living and often in remote locations, leaving people socially isolated. A recent report from Doctors of the World found that asylum accommodation does not meet basic humanitarian standards and contributes to poor health.13 Problems included poor food, lack of access to basic sanitary products, and inability to store medication or have professionals visit to provide care. Residents were unable to obtain prescriptions, medical care for pregnancy and children, referrals to specialists, and ongoing support for medical conditions, and they reported serious mental health effects from the loneliness, isolation, and feelings of being imprisoned.
Urgent reforms
Despite this, the Home Office is introducing a raft of measures that have been described by the UN Refugee Agency as “a recipe for mental and physical ill health” and inconsistent with the 1951 Refugee Convention.14 Measures include legislation to make refugee protection temporary, warehouse style reception centres, and plans to expel asylum seekers to Rwanda.15 Ukrainians who arrive without paperwork could be subjected to any or all of these measures. Instead, reforms should focus on building a humane refugee system that resolves claims quickly and fairly, strengthens long term protection, and recognises the critical importance of security, safe accommodation, community, and access to medical care.
Ukrainians in the UK—largely children, women, and elderly people—need meaningful access to healthcare services, including preventive healthcare, mental healthcare, screening, and maternity services.1 The government, NHS bodies, and frontline services need to reform the policies and practices known to prevent refugees and asylum seekers from accessing care. Currently, Ukrainians without formal immigration status will be charged for hospital services and could face barriers to registering with a general practitioner.16
Achieving meaningful progress will require the Department of Health and Social Care to abandon its NHS charging policy,17 the Home Office to reform GP registration for asylum seekers, and general practices to overhaul their policies and practices in line with the seven steps set out in the safe surgeries initiative.18 The NHS in all devolved nations could use this opportunity to clarify entitlement to primary care services and deal with the culture of bureaucracy and gatekeeping that so often prevents refugees and migrants from accessing medical care.19
Many of the policies outlined above contribute to the government’s policy agenda known as the hostile environment,20 which aims to discourage people from entering the UK without immigration documents and encourage those here to leave. This powerful and pervasive agenda has seeped into (and is enforced by) public services, including the NHS.2122 Only through recognising the intention of this harmful policy agenda, and tackling it head on, can we ensure that Ukrainians and others in need of protection will be able to build a safe and healthy life in the UK.
Footnotes
Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.
Provenance and peer review: Commissioned; not externally peer reviewed.